Perioperative Management of Rheumatoid Arthritis Patients: A Review

Rheumatoid Arthritis (RA) is a systemic autoimmune disease characterized by chronic inflammation, joint destruction, and extra-articular manifestations, often necessitating surgical intervention for pain relief, correction of deformities, and restoration of function. This condition is further complicated by significant comorbidities, including cardiovascular disease, osteoporosis, and interstitial lung disease, which collectively elevate perioperative risks. Surgical interventions in RA patients require tailored perioperative management strategies to address these complexities, including optimizing immunosuppressive therapy, preventing infectious and thromboembolic complications, and mitigating delays in wound healing. This narrative review examines and synthesizes the current literature spanning 2008 to 2022 to provide an in-depth exploration of evidence-based approaches for perioperative management in RA patients. Key areas of focus include preoperative risk stratification, management of disease-modifying antirheumatic drugs (DMARDs) and biologics, intraoperative considerations such as anesthesia and surgical techniques, and postoperative care with a focus on infection prevention and rehabilitation. By highlighting current best practices and identifying knowledge gaps, this review aims to enhance surgical outcomes and guide future research in this complex patient population.